Provider automation

Provider automation provides avenues for electronic claims submission and we support ANSI HIPAA compliant version 5010 transactions.

Simplify your transactions

Capital Blue Cross supports all ANSI HIPAA compliant version 5010 transactions, including:

  • ANSI 835 Electronic Remittance Advice
  • ANSI 837 Institutional Claims
  • ANSI 837 Professional Claims
  • ANSI 270/271 (Eligibility and Benefit Request)
  • ANSI 276/277 (Claim Status Inquiry)
  • ANSI 278 (Health Care Services Review - Request for Review and Response)

Authorization process

Please set up a trading partner relationship prior to sending electronic data interchange (EDI) transactions. This defines a legal relationship and requirements for the exchange of EDI transactions. Contact our support center or provider automation to get started.

Email us or call 800.874.8433, option 4.

Capital Blue Cross support center

Telephone: 717.541.7200

Hours of operation: 24/7

Allow until the next normal business day for for reported problems.

System operating hours

Scheduled outages occur on Sunday at 3:50 AM – 4:50 AM and 8:00 PM – 12:00 AM. Provider automation will notify providers and trading partners via email. We’re closed on the following holidays. Allow until the next business day for technical help.

  • New Year’s day
  • Martin Luther King day
  • Memorial day
  • Independence day
  • Labor day
  • Thanksgiving day and the day after
  • Christmas day (includes either the day before or after)

Enrollment for EDI Direct ANSI Transactions

If your management system processes ANSI transactions, you may enroll for EDI Direct with Capital Blue Cross for the ANSI 835, 837I, 837P, 270/271, 276/277 and 278 transactions. Complete the enrollment form below.


Electronic statement of remittances

If your system cannot process the ANSI 835 ERA, we offer electronic versions:

  • statement of remittance (eSOR)
  • debit balance report (eDBR)
  • claims rejected to member (eCRR)

Electronic versions provide the same information as mailed statements. Access these documents with the secure file transfer (SFT) application on Availity Provider Portal or request direct secure file transfer protocol connection.

Fax the completed form to provider automation at 717.651.4001.

eSOR enrollment form

  • Electronic claims submission offers a range of benefits:
  • Improved administrative efficiencies
  • Reduced cost of submitting claims
  • Reduced manual processing errors and delays
  • Improved payment turnaround time

Methods of electronic submission:

EDI Direct

Participating providers can submit HIPAA compliant files directly to us. Complete the Trading Partner Agreement and test the file for HIPAA and our requirements for transmission.

Email us or call at 800.874.8433, option 4.

Direct Data Entry

Submit CMS 1500 claims securely to Capital Blue Cross. Printable confirmation is displayed after submitting. A report identifying acceptance or rejection of the claim is available the next business day.

Register with Availity Provider Portal, a partner of Capital Blue Cross, to use the DDE claims entry option. Email us or call 800.874.8433 and ask for Provider Automation to see if our DDE service would meet your needs.

Clearinghouses

Utilize a clearinghouse if our direct methods do not suit your needs. We receive EDI claims and ANSI ASC X 12N current HIPAA compliant versions through clearinghouses.

Real Time Eligibility and Benefit and Claim Status Inquiries

We accept ANSI HIPAA compliant version 5010 270 eligibility inquiry real time request. We also accept ANSI HIPAA compliant version 5010 276 claims status inquiry real time requests. These requests include a single inquiry or submission (one eligibility inquiry to one information source for one patient). The response from Capital Blue Cross as the message receiver is either an error response or the corresponding X12 message response (TA1, 999 or 271).

Trading partners should send no more than one transaction per 2 seconds with 5 concurrent transactions.

Submit transactions directly to Capital Blue Cross, through a clearinghouse or vendor arrangement.

Real time processing is available a majority of the calendar week. Our maximum response time between trading partners of 4 seconds or less per hop with a total round trip of 20 seconds or less.